POS1119 EFFICACY OF CORTICOSTEROIDS FOR HAND OSTEOARTHRITIS - A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS
Authors: M. Estee, F. Cicuttini, M. Page, A. Butala, A. Wluka, S. M. Hussain, Y. Wang
Journal: Annals of the Rheumatic Diseases (2022)

Background Hand osteoarthritis (OA) is a prevalent joint condition, causing disabling pain, reduced mobility, impaired daily functioning and quality of life (1-2) . Corticosteroids are anti-inflammatory medications frequently used in musculoskeletal diseases. There is some evidence that corticosteroids may have a beneficial effect in hand osteoarthritis (3-4 ) . Objectives To examine the efficacy of corticosteroids on symptoms and structural outcomes in hand osteoarthritis. Methods Ovid MEDLINE, Embase and Cochrane Central Register of Controlled Trials were searched from inception to October 2021 for randomized controlled trials investigating the efficacy of corticosteroids in hand osteoarthritis. Two authors independently screened records, extracted data, and assessed risk of bias using the RoB 2 tool. Standardized mean difference (SMD) or mean difference was calculated, and random-effects meta-analyses were performed. Results Of 13 included trials, three examined oral and ten examined intra-articular injection of corticosteroids on clinical outcomes. In meta-analysis, oral corticosteroids reduced pain (SMD=-0.53, 95%CI -0.79 to -0.28) and improved function (SMD=-0.37, 95%CI -0.63 to -0.12) at 4-6 weeks, and intra-articular corticosteroid injection improved function (SMD=-0.48, 95%CI -0.90 to -0.06) at 4-6 weeks. Corticosteroids had no significant effects on pain and function over 3 months and 6-12 months. Two trials evaluated joint structure at 4-6 weeks: one study showed oral corticosteroids reduced synovial thickening, neither showed an effect on synovitis. Conclusion There was low-certainty evidence for a medium effect of oral corticosteroids on pain relief and small-to-medium effect on functional improvement at 4-6 weeks. Intra-articular corticosteroids showed low-certainty evidence for a medium effect on functional improvement at 4-6 weeks. Corticosteroids had no significant effect on any outcomes over longer term. No trials examined the effect of corticosteroids on disease progression. The role of corticosteroids in hand osteoarthritis is limited. References [1]Zhang Y, Niu J, Kelly-Hayes M, Chaisson CE, Aliabadi P, Felson DT. Prevalence of Symptomatic Hand Osteoarthritis and Its Impact on Functional Status among the Elderly: The Framingham Study. American Journal of Epidemiology. 2002;156(11):1021-7. [2]Kjeken I, Dagfinrud H, Slatkowsky-Christensen B, Mowinckel P, Uhlig T, Kvien TK, et al. Activity limitations and participation restrictions in women with hand osteoarthritis: patients’ descriptions and associations between dimensions of functioning. Annals of the rheumatic diseases. 2005;64(11):1633-8. [3]Kroon FPB, Kortekaas MC, Boonen A, Böhringer S, Reijnierse M, Rosendaal FR, et al. Results of a 6-week treatment with 10 mg prednisolone in patients with hand osteoarthritis (HOPE): a double-blind, randomised, placebo-controlled trial. Lancet. 2019;394(10213):1993-2001. [4]Kloppenburg M, Kroon FPB, Blanco FJ, Doherty M, Dziedzic KS, Greibrokk E, et al. 2018 update of the EULAR recommendations for the management of hand osteoarthritis. Annals of the Rheumatic Diseases. 2019;78(1):16. Disclosure of Interests None declared